Psychology Intake and Cultural Identity

Intake Questions

• During an intake, a therapist should inquire about the client's interaction with a physician.
• This helps determine if the client has sought medical evaluation for their symptoms and received a diagnosis or treatment recommendations.
• Encouraging communication with a physician emphasizes a collaborative approach between mental health and medical professionals, promoting an integrated care model.
• It also indicates the seriousness of the client’s symptoms, guiding the therapist in developing an appropriate treatment plan.

Influence of Cultural Identity

• Cultural beliefs and values influence individuals’ interpretations of symptoms and experiences.
• Some cultures prioritize collective well-being over individual expression, leading to views of emotional distress as a result of social expectations.
• Cultural norms can shape how individuals articulate their problems in therapy and their acceptable coping mechanisms, potentially causing misunderstandings.

Cultural Influence on Therapy Seeking

• Cultural identity influences stigma associated with mental health issues and seeking therapy.
• Some cultures perceive mental health concerns as taboo or a sign of weakness, leading to reluctance to seek help.
• Conversely, cultures that prioritize mental wellness and self-care may view therapy as a proactive and positive step.

Cultural Impact on Client-Therapist Relationship

• Cultural backgrounds of both client and therapist can influence their therapeutic rapport.
• Factors like language, values, communication styles, and shared experiences can enhance or create barriers in the relationship.
• A strong therapeutic alliance builds trust and creates a secure space for sharing vulnerabilities, facilitating effective treatment.

Culturally Responsive Care

• Tailoring treatment to align with the client's cultural identity and values makes care more effective and personalized.

Cultural Concepts Related to Psychiatric Diagnosis & Treatment

• Cultural background influences symptom expression, affecting diagnosis accuracy.
• Variations in emotional expression can lead to misinterpretations of mental health conditions.
• Cultural beliefs associated with mental health, illness, and treatment vary.
• Understanding these beliefs helps clinicians approach treatment with sensitivity and increase client engagement.
• Cultural identity affects willingness to participate in therapy.
• Recognizing cultural norms can foster trust and improve communication.

Assessment of Engagement

• Understanding a client's readiness to change helps gauge their level of engagement and willingness to participate in therapy.
• Adapted approaches can then better support the client's needs.

Facilitating Effective Interventions

• Therapists can use strategies that align with a client's level of motivation.
• Ambivalent clients may benefit from exploring the pros and cons of change, while motivated clients can work on actionable steps towards their goals.

Enhancing Outcomes

• Aligning interventions with a client's stage in the change process enhances outcomes.

Adjustment Disorder

• The focus of treatment for adjustment disorder is to help individuals develop coping strategies and support systems to manage their emotional responses to stressors.
• Promising therapeutic approaches include cognitive-behavioral therapy (CBT) and supportive therapy.
• The prognosis for adjustment disorders is generally favorable as symptoms often resolve with intervention, typically within six months after the stressor is removed.

Disruptive Mood Dysregulation Disorder (DMDD)

• Outbursts in DMDD can be verbal (e.g., temper tantrums) or physical (e.g., physical aggression).
• Consider the child's developmental level and the context of the outbursts.
• Outbursts must occur on average three or more times per week.
• The individual's mood is typically irritable or angry between outbursts.

Major Depressive Episode

• Common depressive symptoms include depressed mood, loss of interest in activities, changes in appetite, sleep disturbances, fatigue, feelings of worthlessness or guilt, and impaired concentration.
• A minimum of five symptoms are required, and they must persist for at least two weeks.

Distinguishing Grief from Major Depressive Disorder

• Typical grief includes intermittent feelings of sadness and loss but allows for moments of happiness.
• Major depressive disorder involves persistent, pervasive symptoms, lack of interest, and may include feelings of worthlessness or suicidal thoughts.

Persistent Depressive Disorder

• Persistent depressive disorder requires depressed mood and at least two additional symptoms for at least two years.

Panic Disorder

• Panic attacks in panic disorder are typically unexpected.
• One attack is not sufficient for diagnosis.
• In addition to recurrent panic attacks, Criterion B requires the presence of one month or more of persistent worry about having additional attacks or significant behavioral changes related to the attacks.

Panic Attack Symptoms

• Common symptoms of a panic attack include rapid heart rate, shortness of breath, dizziness, sweating, trembling, feelings of choking, and fears of losing control or dying.
• At least four symptoms from the DSM-5 criteria are needed to qualify as a panic attack.

Agoraphobia

• For a person with agoraphobia, the perceived threat arises from situations where escape might be difficult or help unavailable in the event of a panic attack.
• The individual is concerned that developing panic-like symptoms could lead to embarrassment or incapacitation.
• The symptoms and fears must occur in two or more settings (e.g., using public transportation, being in crowded places, or being outside alone).

Contributing Factors to Anxiety Symptoms

• Substances, medications, and medical conditions can contribute to or exacerbate anxiety symptoms.
• Assessing these factors is essential for an accurate diagnosis and effective treatment.

Separation Anxiety Disorder

• Involving parents is crucial in treating children with separation anxiety disorder to implement coping strategies and support the child's progress.

External Exposure in Treatment

• In the agoraphobia and snake phobia videos, external exposure involved gradually exposing the individuals to their feared situations.
• The person must remain in the anxiety-provoking situation "long enough" for anxiety to peak and then decline, and practice exposure "often enough" to extinguish the anxiety.
• Expectancy violation occurs when individuals confront their fears, leading to revised, less fearful cognitions.

Medications and Interoceptive Exposure

• Medications may dampen physiological responses associated with anxiety, hindering the exposure process and the opportunity for habituation to occur.
• The prognosis for treating specific phobias is generally favorable, especially with exposure therapy combined with other treatments.

Exam Format

• The exam will consist of 65 multiple-choice items.

Asking Questions in Therapy

• Seeking information about symptoms, triggers, and coping mechanisms allows for tailored treatment
• Encouraging self-reflection and clear articulation of emotions provides greater insights into the client's situation
• Open and honest dialogue strengthens the bond between the client and therapist which is essential for effective treatment

Medical Factors in Therapy

• Physical health conditions such as thyroid disorders, neurological issues, or chronic illnesses can have symptoms that mimic or exacerbate mental health problems
• Substance use, including alcohol, drugs, and prescribed medications can also trigger or worsen mental health issues
• Understanding the client's medical history allows for a holistic treatment approach and addresses both physical and psychological needs
• It also helps therapists assess potential risks and ensure appropriate referrals for medical help

Cultural Influence on Therapy

• Individual cultures have varying beliefs about mental health and different means of addressing them
• Cultural understanding can facilitate respectful treatment and tailor therapy to meet the needs of the client
• The person-centered approach prioritizes the client's experience and values, contributing to effective treatment planning

Cultural Impact On Diagnosis and Treatment

• Cultural background affects how individuals express symptoms, which can influence diagnostic accuracy
• Cultural beliefs shape how individuals understand and approach mental health, impacting their engagement with treatment
• Incorporating cultural considerations into treatment plans can enhance trust, communication, and the effectiveness of care for every individual

Motivation in Therapy

• Understanding a client's readiness for change allows for tailored therapeutic approaches
• Therapists can tailor interventions to match the client's level of motivation
• Motivated clients can work on tangible steps toward their goals, while hesitant clients might need to explore the pros and cons of change
• Effective engagement and motivation lead to successful treatment outcomes

Importance of Therapeutic Alliance

• A positive therapeutic relationship is crucial for effective treatment
• It fosters trust and safety, encouraging open communication and deeper exploration of issues
• It encourages client engagement and motivation which is vital for successful treatment outcomes
• A strong therapeutic alliance is a predictor of positive treatment results

Other Conditions that May Be a Focus of Clinical Attention

• These conditions are not mental health disorders but influence a client's overall well-being
• They help to understand the client's journey and guide therapy planning
• Relational problems, such as family conflict or partner difficulties, can impact a client's mental health
• Traumatic events, or ongoing stressors, can have a significant influence on mental health, even if they do not meet the criteria for PTSD

Adjustment Disorders

• The primary focus of treatment is to help individuals develop coping strategies and support systems
• Promising approaches include cognitive-behavioral therapy (CBT) and supportive therapy.
• Treatment is generally effective, with symptoms usually resolving within six months

Disruptive Mood Dysregulation Disorder (DMDD)

• Outbursts can be verbal, like tantrums, or physical, like aggression
• It is important to consider the child's developmental stage and the context of the outbursts
• Outbursts must occur on average at least three times per week and are often accompanied by irritable or angry moods between outbursts

Major Depressive Episode

• Common symptoms include depressed mood, disinterest in activities, changes in appetite, sleep disturbances, feelings of worthlessness, guilt, and impaired concentration
• At least five symptoms are required and must persist for at least two weeks

Distinguishing Typical Grief from Major Depressive Disorder

• Typical grief includes intermittent periods of sadness and loss, with moments of joy and happiness
• Major depressive disorder is characterized by persistent symptoms, lack of interest, intense feelings of worthlessness, and suicidal thoughts, which significantly impair functioning

Persistent Depressive Disorder

• It involves a depressed mood and at least two additional symptoms
• These symptoms must persist for at least two years

Therapeutic Alliance

• Building trust between therapist and client
• Creates a secure space for vulnerability
• Facilitates effective treatment

Culturally Responsive Care

• Therapist considers the client's cultural identity and values
• Integrates these factors into the therapy process
• Personalized care for more effectiveness

Cultural Concepts in Psychiatric Diagnosis and Treatment

• Influence on Symptom Expression: Cultural background influences how individuals express and experience mental health symptoms
• Cultural Beliefs about Mental Health: Different cultures have varying beliefs on mental health, illness, and treatment
  • Understanding these beliefs can help clinicians approach treatment with sensitivity
  • Increase client engagement
• Impact on Treatment Engagement: A client's culture influences their willingness to participate in therapy
  • Recognizing cultural norms can foster trust and improve communication
• Tailored Interventions: Incorporating cultural concepts allows for personalized treatment aligned with clients' values
  • Enhances acceptance and effectiveness of care

Assessment of Engagement

• Understand client's readiness to change
• Gauge their level of engagement and willingness to participate in therapy
• Adapt approach to better support client needs

Facilitating Effective Interventions

• Therapists recognize and respect a client's current level of motivation
• Employ strategies that resonate with client's readiness
  • Ambivalent clients: explore the pros and cons of change
  • Motivated clients: focus on actionable steps towards their goals

Enhancing Outcomes

• Address motivation for interventions aligning with client's change process
• Foster motivation for client movement through stages of change
• Lead to successful outcomes

Trust and Safety in Therapeutic Relationship

• Creates a safe environment for clients to share thoughts and feelings
• Leads to deeper exploration of issues

Client Engagement and Motivation

• Clients feel understood by their therapist
• Increase active engagement in therapy and commitment to treatment plans

Facilitates Communication in Therapeutic Relationship

• Encourages open dialogue and communication
• Allows therapists to tailor interventions to better meet client's needs

Influences Treatment Retention

• Clients with a strong therapeutic connection attend sessions consistently
• Vital for achieving lasting change

Predicts Positive Outcomes

• Research shows that a robust therapeutic alliance predicts positive treatment outcomes
• May be more influential than the type of therapy or theoretical orientation

DSM-5-TR: Other Conditions That May Be a Focus of Clinical Attention

• Conditions are not classified as mental health disorders
• Serve to alert practitioners to potential influences on mental health
  • Can be addressed in therapy or treatment planning

Relational Problems

• Family conflict, partner relational distress, and parenting problems
• Significantly affect an individual's mental health and well-being

Post-Traumatic Stress Disorder (PTSD) Related to Specific Situations or Events

• The impact of specific traumatic events or ongoing stressors
• Do not fully meet criteria for PTSD
• Warrant clinical attention

Adjustment Disorders

• Symptoms start within three months of a specific stressor
• Difficulty performing daily tasks, increased absenteeism, relationship issues, or social withdrawal
• Symptoms typically resolve within six months after the stressor ends
• Symptoms persisting beyond six months may indicate chronic adjustment difficulties

Prolonged Grief Disorder

• Persistent, intense yearning for the deceased or persistent intense sorrow or emotional pain in response to death
• Symptoms must be present for six months or longer following the death
• The death must have occurred at least six months prior to the assessment

Adjustment to Life Stressors

• Individuals who adjust more easily: Have strong coping skills, social support, and resilience
• Individuals more susceptible: Exhibit lower self-esteem, lack of coping strategies, and higher levels of neuroticism

Treatment for Adjustment Disorder

• Focus on developing coping skills, and support systems
• Promising therapeutic approaches: Cognitive-behavioral therapy (CBT) and supportive therapy
• Prognosis: Generally favorable with symptoms resolving with appropriate intervention

Disruptive Mood Dysregulation Disorder (DMDD)

• Outbursts can be verbal (temper tantrums) or physical (aggression)
• Consider the child's developmental level and context
• Outbursts must occur on average three or more times per week
• Individual's mood is typically irritable or angry between outbursts

Major Depressive Episode DSM-5 Criteria

• Depressed mood, loss of interest, changes in appetite, sleep disturbances, fatigue, feelings of worthlessness or guilt, and impaired concentration
• Minimum of five symptoms are required for at least two weeks

Distinguish Grief From Depression

• Typical grief involves intermittent sadness and loss with moments of happiness
• Major depressive disorder involves persistent, pervasive symptoms, lack of interest, intense feelings of worthlessness, or suicidal thoughts

Persistent Depressive Disorder

• Depressed mood and two additional symptoms
• Symptoms present for at least two years
• Panic attacks are typically unexpected and persistent worry about additional attacks or significant behavior changes related to attacks

Panic Attacks

• Rapid heart rate, shortness of breath, dizziness, sweating, trembling, feelings of choking, and fears of losing control or dying
• Four or more symptoms from the DSM-5 criteria

Agoraphobia

• Perceived threat arises from situations where escape might be difficult or help unavailable
• Concerned about developing panic-like symptoms leading to embarrassment or incapacitation
• Symptoms and fears must occur in two or more settings

Substance, Medications, and Medical Conditions Contributing to Anxiety

• Substances (alcohol or drugs), medications, and medical conditions can contribute to anxiety symptoms
• Evaluate factors for an accurate diagnosis and effective treatment

Separation Anxiety Disorder

• Involving parents in treatment is crucial
• Parents can help implement coping strategies and support the child's progression

Common Depression Symptoms in DSM-5 Criteria

• Common symptoms: Depressed mood, loss of interest in activities, changes in appetite, sleep disturbances, fatigue, feelings of worthlessness or guilt, and impaired concentration
• Number of symptoms required: Minimum of five
• Duration of symptoms: Persist for at least two weeks

Intake Interviewing

• The presenting problem is the client's primary concern or reason for seeking therapy.
• It's important to ask clients what their presenting problem means to them and what they experience when they are having it.
• Therapists need to understand a client's medical history to rule out any medical conditions that might be contributing to their presenting problems.
• Cultural identity can influence how clients understand their presenting problem, their views on seeking therapy, and their relationship with the therapist.

DSM-5-TR: Cultural Formulation

• Cultural concepts are important to consider in psychiatric diagnosis and treatment because mental health experiences and expressions can vary across cultures.

Seligman Chapter 1: Introduction to Effective Treatment Planning

• The DSM-5-TR lists “Other Conditions That May Be a Focus of Clinical Attention” (Z codes) which include factors that may be impacting a person's mental health but do not meet the criteria for a formal diagnosis.
• The DSM-5-TR includes Adjustment Disorders which are characterized by emotional or behavioral symptoms that develop in response to a stressful life event.
• The DSM-5-TR includes Prolonged Grief Disorder which is characterized by intense and debilitating grief that persists for at least 12 months after the loss of a loved one.

DSM-5-TR: Adjustment Disorders

• Adjustment disorder symptoms must begin within 3 months of a stressful event, and there must be evidence that the symptoms are clinically significant.
• Symptoms of Adjustment Disorder must persist for less than 6 months, and they must not persist beyond 6 months after the stressor has ended.

DSM-5-TR: Prolonged Grief Disorder

• Prolonged grief disorder requires at least one of two symptoms characterizing the development of a persistent grief response:
  • Intense yearning or longing for the deceased person
  • Intense sorrow or emotional pain over the deceased person
• These symptoms must be present for at least 12 months and must have begun within 6 months of the death.

Reichenberg Chapter 8: Situationally Precipitated Disorders and Conditions

• Individuals who adjust more easily to life stressors tend to have good coping skills, social support, and a positive outlook.
• Individuals who are more susceptible to adjustment disorder may have a history of mental health issues, poor coping skills, limited social support, and a more negative outlook.
• The primary focus of treatment for adjustment disorder is to help the individual cope with the stressor and develop healthy strategies for managing their emotions.
• Two promising therapeutic approaches are cognitive behavioral therapy (CBT) and psychodynamic therapy.
• The prognosis for adjustment disorders is generally good, with most individuals recovering within a few months.

DSM-5-TR: Depressive Disorders

• This chapter includes information on various diagnoses related to depressed mood, including Major Depressive Disorder, Persistent Depressive Disorder, and Premenstrual Dysphoric Disorder.

DSM -5-TR: Anxiety Disorders

• Separation Anxiety Disorder is characterized by excessive anxiety and distress about being separated from attachment figures. It's not the same as the typical separation anxiety seen in childhood.
• Specific Phobias are characterized by an intense fear of a specific object or situation that is out of proportion to the actual danger. The phobia must last for at least six months.
• The first DSM criterion for Social Anxiety Disorder is a fear of social situations where the individual is exposed to possible scrutiny. The perceived threat is negative evaluation from others.
• Panic attacks in Panic Disorder are unexpected, meaning they occur without any apparent trigger. A single panic attack is not enough for a diagnosis. One or more panic attacks must be followed by at least one month of persistent worry about having more attacks or about the consequences of the attacks.
• Common symptoms of a panic attack include rapid heart rate, sweating, trembling, shortness of breath, dizziness, chest pain, nausea, and a sense of detachment from reality. At least four of these symptoms are needed for a panic attack.
• Agoraphobia is characterized by a fear of situations where escape might be difficult or help unavailable if the person develops anxiety or panic-like symptoms. Individuals with Agoraphobia are concerned about having panic attacks or about other embarrassing symptoms such as dizziness, incontinence, or tremors. There are at least two distinct situations where this fear occurs.
• Substances, medications, and medical conditions can all contribute to anxiety symptoms.

Reichenberg Chapter 6 and Related Class Material on Anxiety Disorders

• It is important to involve parents when treating children with Separation Anxiety Disorder.
• The external exposure technique in therapy involves gradually exposing the individual to the feared situation, often starting with a safe, controlled setting.
• Habituation is a process where the individual's anxiety gradually decreases over time as they are exposed to the feared situation. It involves staying in the situation long enough for the anxiety to reach its peak and then decline, and repeating the exposure often enough for habituation to occur.
• Expectancy violation is a technique where the therapist helps the person challenge negative thoughts or beliefs about the feared situation. The desired effect is to revise those cognitions.
• It's important to be concerned about using medications prior to interoceptive exposure in the treatment of phobias or other anxiety disorders, as these have the potential to suppress anxiety symptoms and interfere with the habituation process.
• The prognosis for the treatment of specific phobias is favorable.
• Social Anxiety Disorder treatment involves two components: cognitive behavioral therapy (CBT) and social skills training.
• Therapists can help individuals with panic disorder by providing psychoeducation on panic symptoms and reframing them.
• Panic Control Therapy involves interoceptive (internal) exposure, where the therapist helps the individual create panic-like sensations through various techniques. The goal is to help the person become accustomed to these sensations and realize that they are uncomfortable but not dangerous.
• The treatment of choice for panic disorder is cognitive behavioral therapy (CBT).

DSM-5-TR: Bipolar and Related Disorders

• This chapter provides detail on Bipolar I Disorder, Bipolar II Disorder, and Cyclothymic Disorder.

DSM-5-TR: Personality Disorders

• The DSM-5-TR includes information on ten personality disorders, including Antisocial, Avoidant, Borderline, Dependent, Histrionic, Narcissistic, Obsessive-Compulsive, Paranoid, Schizoid, and Schizotypal Personality Disorder.